Journal of Musculoskeletal Trauma

Current Concepts of Vitamin D and Calcium in the Healing of Fractures: Jihyo Hwang; J Korean Fract Soc 2021;34(3):117-121. Published online July 31, 2021; DOI: https://doi.org/10.12671/jkfs.2021.34.3.117

Abstract PDF: Fragile fractures, also known as osteoporosis fractures, insufficiency fractures, and senile fractures are a significant problem encountered by orthopedic surgeons. Calcium and vitamin D are essential for maintaining bone health and deficiencies in calcium and vitamin D are major risk factors for the development of osteoporosis. Sufficient amounts of calcium are also required for fracture-callus mineralization. Hence, compromised bone repair that is frequently observed in osteoporotic patients might be attributed to calcium and vitamin D deficiencies. Consequently, calcium and vitamin D supplementation represents a potential strategy for treating compromised fracture healing in osteoporotic patients. There is some clinical evidence of the positive effect of supplementation in fracture healing and posttraumatic bone turnover, but research in this area is ongoing. Calcium and vitamin D should be the primary treatment of choice in osteopenic patients with an insufficiency of calcium and vitamin D and for the prevention of secondary osteoporotic fractures. Calcium and vitamin D can also be used as addition to other primary osteoporotic medications such as antiresorptive or bone-forming agents. The role of calcium and vitamin D in fracture healing and the therapeutic potential of calcium and vitamin D supplementation is summarized in this context.

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The Role of Beta-Tricalcium Phosphate Graft in the Dynamic Hip Screw Fixation of Unstable Intertrochanter Fracture: Chul Ho Kim, Ji Wan Kim, Eic Ju Lim, Jae Suk Chang; J Korean Fract Soc 2016;29(4):250-257. Published online October 31, 2016; DOI: https://doi.org/10.12671/jkfs.2016.29.4.250

Abstract PDF: PURPOSE
The purpose of this study was to introduce our method of stabilizing unstable intertrochanteric fractures by using the dynamic hip screw (DHS) with a beta-tricalcium phosphate (Î²-TCP) graft and to compare the outcomes of this procedure with those of the conventional DHS without Î²-TCP.
MATERIALS AND METHODS
Patients who underwent surgery by using DHS between March 2002 and January 2016 were retrospectively reviewed for analysis of the outcomes. The inclusion criteria were: 1) age of 60 years and older; 2) low-energy fracture resulting from a fall from no greater than the standing height; 3) multifragmentary pertrochanteric fracture (AO classification 31-A2.2, 2.3); and 4) follow-up of over 3 months. We compared 29 patients (29 hips) who underwent surgery, using DHS without Î²-TCP, with 29 age-sex matched patients (29 hips) who underwent surgery using DHS with grafted Î²-TCP granules to empty the trochanter area after reaming. We investigated the fracture union rate, union time, and length of lag screw sliding.
RESULTS
Bone union was achieved in all cases. The mean union time was 7.0 weeks in the Î²-TCP group and 8 .8 weeks in the non-Î²-TCP group. The length of lag screw sliding was 3.6 mm in the Î²-TCP group and 5 .5 mm in the non-Î²-TCP group. There were no implant failure cases in both groups.
CONCLUSION
The Î²-TCP graft for reinforcement DHS acquired satisfactory clinical outcomes for treating unstable intertrochanteric fractures.

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Effect of injected calcium-sulfate on the consolidation of distraction osteogenesis in rabbit model: Chang Wug Oh, Poong Taek Kim, Byung Chul Park, Il Hyung Park, Hee Soo Kyung, Seung Hoon Baek; J Korean Soc Fract 2002;15(2):271-277. Published online April 30, 2002; DOI: https://doi.org/10.12671/jksf.2002.15.2.271

Abstract PDF: PURPOSE
To investigate whether injection of calcium sulfate salt powder could be used to facilitate consolidation of early & fast distraction osteogenesis.
MATERIALS AND METHODS
Group I was experimental group and Groups II and III were controls. After 3 days of latency period, a small distractor was distracted for a total of 8 mm for 4 days. Calcium sulfate salt powder suspended in carboxymethylcellulose(CMC) solution was injected, whereas CMC media alone was injected in one control group and without intervention in the other control group. Plain radiographs were taken on every weeks. We assesed the bone mineral density(BMD) at 3 and 6 weeks and %BMD was calculated. The rabbits were sacrificed at 6 weeks for histologic examination.
RESULTS
In radiography, the distracted area was consolidated in the experimental group but not in control groups. The % BMD of the experimental group was significantly greater than that of control groups at 6 weeks(p<0.01). In histologic examination, greater amount of newly formed bone was noted in the distraction zone of the experimental group, compared to two control groups.
CONCLUSION
Implantation of calcium sulfate powder can accelerate consolidation in distraction osteogenesis in rabbits.

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Effect of Insertion of Bone Graft Substitutes on Consolidation of Distracted Callus: Changes of Radiography & Bone Mineral Density in the Tibia of Rabbits: Chang Wug Oh, Poong Taek Kim, Byung Chul Park, Hae Ryong Song, Il Hyung Park, Jun Ho Baek, Hyung Jin Park; J Korean Soc Fract 2000;13(4):687-695. Published online October 31, 2000; DOI: https://doi.org/10.12671/jksf.2000.13.4.687

Abstract PDF: PURPOSE
This study was designed to know the effect of calcium-sulfate and xenograft on the distracted callus after lengthening.
MATERIALS AND METHODS
We had operation of subperiosteal osteotomy and external fixation on the tibial diaphysis of young New Zealand White rabbits(2.0-2.5kg); after 5 days of latency period, 7 mm(1mm/day, 2 times/day) of tibial lengthening was reached in a week. At 1 week after lengthening, the 1st experimental group of 7 rabbits received a pellet of calcium sulfate(Osteoset , Wright medical, USA) in the distraction gap, and the 2nd experimental group of 7 rabbits received 5mm2 of xenogrfat(Lubboc ) in the distraction gap. But, the control group of 7 rabbits did not receive any of above materials. We compared three groups with the changes of radiographic findings at every week and bone mineral ratio(DEXA) at every two weeks.
RESULTS
The time to complete consolidation of distraction callus of both experimental group(calcium sulfate;14 weeks, xenograft; 15.4 weeks) was shorter than that of control group(16.9 weeks) in radiographic findings. Maximum value of bone mineral ratio of distraction callus was higher and the time to reach the highest value was also shortened in the both experimental group compared to control group.
CONCLUSION
By use of bone substitutes as like calcium sulfate or xenograft in the distraction callus with external fixator, it may be possible to shorten the consolidation period and the fixator-wearing period.

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